HLTH 8465 Week 1 Collaborative Strategy Framing Post Example

Week 1 Discussion: Initial Post and Replies

Strategy Without a Chain of Command Is What Independent Partners Keep Agreeing To

Where no organization can instruct another, any plan one partner writes is only a proposal, and the strategy is the pattern all of them end up enacting. I want to test that claim on a composite county where four bodies, each answering to its own board or electorate, absorb the same gap in adult crisis care.

The partners, named by role only, are two hospital systems that compete for the same insured patients, a larger regional system and a smaller independent hospital; the county behavioral health authority, which funds community crisis services; and the sheriff's office, whose deputies are the ones who end up waiting in emergency departments with adults in crisis because there is nowhere else to take them. Each could walk away from any joint plan. The larger system can build what it wants on its own balance sheet. The independent hospital worries, with reason, about sharing patient flows with its rival. The authority answers to the county commission and its state funders. The sheriff answers to voters. National guidance on crisis care describes exactly the gap these four share: adults in crisis need somewhere to go other than an emergency department or a jail (Substance Abuse and Mental Health Services Administration, 2020).

Mintzberg and Waters distinguished deliberate strategy, what an organization intends and then carries out, from emergent strategy, a pattern that forms in a stream of actions whether or not anyone intended it (Mintzberg & Waters, 1985). In this county, each partner has a deliberate strategy of its own. The larger system intends to expand behavioral health beds. The authority intends to fund mobile crisis teams. The sheriff intends to cut deputy hours spent in emergency departments. But the emergent pattern, what the four have actually been doing together for years, is something none of them intends: routing adults in crisis to whichever emergency department is closest, where they wait for hours, while deputies stand by. That pattern is the county's real crisis strategy, and no single partner's plan can change it.

The commitment I expect to be hardest to obtain is the independent hospital's. A shared crisis receiving center staffed partly by the larger system would put the independent hospital's referral patterns in its rival's view, and the independent hospital gains least from a center it could not control. Resource dependence theory would predict that an organization in that position seeks to limit its new reliance on a stronger partner before it commits (Pfeffer & Salancik, 1978). If it declines, the others can still act, but the new pattern would be built around the gap it leaves.

Reply to Maya

Maya, your example of a hospital system aligning its three campuses around a single stroke protocol is a good planning case, but I am not sure it tests the course's question. All three campuses answer to the same board, so the system's leadership can instruct them, and the plan is a deliberate strategy carried out through a chain of command. Is there anyone in your example who could refuse without consequences, such as an independent physician group or an emergency medical services agency? If so, the strategy question would become how to win their agreement, which is where I think this course is pointing.

Reply to Devon

Devon, you describe three agencies in your county that each intend to reduce homelessness among adults leaving the hospital. I wonder what the emergent pattern looks like if you read it from their actions rather than their plans. If each agency discharges or refers to whichever shelter has a bed that night, the realized strategy may be shelter rotation, which none of them intends. Naming that pattern might be the strongest opening for your plan, because it is something all three already share.

References

Mintzberg, H., & Waters, J. A. (1985). Of strategies, deliberate and emergent. Strategic Management Journal, 6(3), 257-272. https://doi.org/10.1002/smj.4250060306

Pfeffer, J., & Salancik, G. R. (1978). The external control of organizations: A resource dependence perspective. Harper & Row.

Substance Abuse and Mental Health Services Administration. (2020). National guidelines for behavioral health crisis care: Best practice toolkit. Substance Abuse and Mental Health Services Administration.